Unplanned Inpatient and Observation Rehospitalizations After Acute Myocardial Infarction

Hess, Connie N.; Wang, Tracy Y.; McCoy, Lisa A.; Messenger, John C.; Effron, Mark B.; Zettler, Marjorie E.; Henry, Timothy D.; Peterson, Eric D.; Fonarow, Gregg C.

doi:10.1161/circulationaha.115.017001

Cited by 27 publications

(10 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This increased readmission risk does not only apply to patients with formal mental illness diagnoses. Self-reported depressive symptoms and low quality of life ratings, have been found to be the patient-level characteristics, most strongly associated with readmission following AMI (14). …”

Section: Introductionmentioning

confidence: 99%

Effective mental health interventions to reduce hospital readmission rates: a systematic review

Benjenk¹,

Chen²

2018

J Hosp Manag Health Policy

View full text Add to dashboard Cite

Background: Hospitals in the United States are financially penalized for having a higher than expected thirty-day readmission ratio among patients initially hospitalized for heart failure, acute myocardial infarction (AMI), pneumonia, chronic obstructive pulmonary disease (COPD), coronary artery bypass graft (CABG) surgery, or hip and knee replacement. Patients hospitalized for these conditions that have comorbid mental health diagnoses or symptoms are at high risk for readmission. Methods: We conducted a systematic review to determine if interventions, that are specifically designed to assess or treat mental health symptoms, can effectively reduce risk of readmission following hospitalization for physical health conditions. We searched on PubMed and Google Scholar for peer-reviewed articles published between January 2010 and June 2018 that examined the impact of mental-health interventions on readmissions for physical conditions. Results: After screening 81 full text articles, we found eleven intervention studies, one meta-analysis, and one cross-sectional study that met our inclusion criteria. Only three of the intervention studies found significant differences in readmission rates between intervention and comparison groups. Each of these interventions targeted patients after discharge from the hospital. One of the interventions was a physical health telemonitoring and individual psychotherapy intervention for patients that were initially admitted for heart failure. The second intervention was individual and group psychotherapy sessions for patients who were initially admitted for AMI. The third intervention was a nurse-driven depression care management protocol for home care patients with depressive symptoms who were initially admitted for any physical health condition. The cross-sectional study showed that communities with a stronger, social-based public mental health infrastructure had significantly lower physical health readmission rates. Conclusions: The literature identified in this review, appears to provide support for the use of mental health interventions after discharge as a mechanism for reducing physical health condition readmissions. Future research is needed to determine if these interventions can specifically reduce thirty-day readmissions for the six conditions linked to financial penalties.

show abstract

Section: Introductionmentioning

confidence: 99%

Effective mental health interventions to reduce hospital readmission rates: a systematic review

Benjenk¹,

Chen²

2018

J Hosp Manag Health Policy

View full text Add to dashboard Cite

show abstract

“…Accurate risk stratification and diagnostic testing are critical for time dependent therapies that restore blood flow to the compromised myocardium, thereby reducing morbidity and mortality and avoiding inappropriate hospital discharge (Hess et al, ; Pelter, ). To minimize total ischemic burden time, the American Heart Association and European Society of Cardiology (AHA/ESC) recommend that individuals with chest pain seek medical attention immediately and receive a 12‐lead electrocardiogram (ECG) within 10 min of hospital arrival, based on evidence that longer delays are associated with adverse prognoses (O'Gara et al, ).…”

Section: Introductionmentioning

confidence: 99%

Patient‐reported symptoms improve prediction of acute coronary syndrome in the emergency department

Zègre‐Hemsey

Burke

DeVon

2018

Research in Nursing & Health

View full text Add to dashboard Cite

Early diagnosis is critical in the management of patients with acute coronary syndrome (ACS), particularly ST-elevation myocardial infarction (STEMI), because effective therapies are time-dependent. Aims of this secondary analysis were to determine: (i) the prognostic value of symptoms for an ACS diagnosis in conjunction with electrocardiographic (ECG) and troponin results; and (ii) if any of 13 symptoms were associated with prehospital delay in those presenting to the emergency department (ED) with potential ACS. Patients receiving a cardiac evaluation in the ED were eligible for the study. Thirteen patient-reported symptoms were assessed in triage. Prehospital delay time was calculated as the time from symptom onset until registration in the ED. A total of 1,064 patients were enrolled in five EDs. The sample was 62% male, 70% white, and had a mean age of 60.2 years. Of 474 participants diagnosed with ACS, 118 (25%) had STEMI; 251 (53%) had non-ST elevation myocardial infarction (NSTEMI); and 105 (22%) had unstable angina. Sweating (OR = 1.42 CI [1.01, 2.00]) and shoulder pain (OR = 1.64 CI [1.13, 2.38]) added to the predictive value of an ACS diagnosis when combined with ECG and troponin results. Shortness of breath (OR = 0.71 CI [0.50, 1.00]) and unusual fatigue (OR = 0.60 CI [0.42, 0.84]) were predictive of a non-ACS diagnosis. Sweating predicted shorter prehospital delay (HR = 1.35, CI [1.10, 1.67]); shortness of breath (HR = 0.73 CI [0.60, 0.89]) and unusual fatigue (HR = 0.72, CI [0.57, 0.90]) were associated with longer prehospital delay. Patient-reported symptoms are significantly associated with ACS diagnoses and prehospital delay. Sweating and shoulder pain combined with ECG signs of ischemia may improve the timely detection of ACS in the ED.

show abstract

“…In comparison with white pa- tients and men, black patients and women were less likely to be employed and reported greater financial burden of medications, potentially resulting in greater overall financial stress and, more specifically, reduced access to health care, evidence-based post-MI treatments, and antianginal medications. Black and female patients also reported lower quality of life, which is another factor associated with worse post-MI outcomes 17 ; this may reflect not only financial difficulties and worse physical condition, but also perhaps other stressors, such as the role of primary caregiver in a family and poor mental well-being. In addition, a prior study examining race and 30-day readmissions after MI, pneumonia, and heart failure among Medicare beneficiaries found that disparities in readmission rates were related not only to race, but also to hospital site.…”

Section: Discussionmentioning

confidence: 99%

“…As previously defined, 17 rehospitalizations were any hospital visits involving at least 1 overnight stay and included inpatient readmission or observation stays as classified by hospital billing data. Hospital visits without an overnight stay and rehabilitation visits were not considered rehospitalizations.…”

Section: Clinical Perspectivementioning

confidence: 99%

Race and Sex Differences in Post–Myocardial Infarction Angina Frequency and Risk of 1-Year Unplanned Rehospitalization

et al. 2017

Self Cite

View full text Add to dashboard Cite

ORIGINAL RESEARCH ARTICLEBACKGROUND: Race and sex disparities in in-hospital treatment and outcomes of patients with acute myocardial infarction (MI) have been described, but little is known about race and sex differences in post-MI angina and long-term risk of unplanned rehospitalization. We examined race and sex differences in post-MI angina frequency and 1-year unplanned rehospitalization to identify factors associated with unplanned rehospitalization, testing for whether race and sex modify these relationships. METHODS: Using TRANSLATE-ACS (Treatment With Adenosine DiphosphateReceptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events after Acute Coronary Syndrome) data, we examined 6-week and 1-year angina frequency and 1-year unplanned rehospitalization stratified by race and sex among MI patients treated with percutaneous coronary intervention. We used multivariable logistic regression to assess factors associated with unplanned rehospitalization and tested for interactions among angina frequency, race, and sex. RESULTS:A total of 11 595 MI patients survived to 1 year postdischarge; there were 66.6% white male patients, 24.3% white female patients, 5.3% black male patients, and 3.8% black female patients. Overall, 29.7% had angina at 6 weeks, and 20.6% had angina at 1 year postdischarge. Relative to white patients, black patients were more likely to have angina at 6 weeks (female: 44.2% versus 31.8%; male: 33.5% versus 27.1%; both P<0.0001) and 1 year (female: 49.4% versus 38.9%; male: 46.3% versus 31.1%; both P<0.0001). Rates of 1-year unplanned rehospitalization were highest among black female patients (44.1%), followed by white female patients (38.4%), black male patients (36.4%), and white male patients (30.2%, P<0.0001). In the multivariable model, 6-week angina was most strongly associated with unplanned rehospitalization (hazard ratio, 1.49; 95% confidence interval, 1.36-1.62; P<0.0001); this relationship was not modified by race or sex (adjusted 3-way P interaction =0.41). CONCLUSIONS:One-fifth of MI patients treated with percutaneous coronary intervention report 1-year postdischarge angina, with black and female patients more likely to have angina and to be rehospitalized. Better treatment of post-MI angina may improve patient quality of life and quality of care and help to lower rates of rehospitalization overall and particularly among black and female patients, given their high prevalence of post-MI angina.

show abstract

Unplanned Inpatient and Observation Rehospitalizations After Acute Myocardial Infarction

Cited by 27 publications

References 29 publications

Effective mental health interventions to reduce hospital readmission rates: a systematic review

Effective mental health interventions to reduce hospital readmission rates: a systematic review

Patient‐reported symptoms improve prediction of acute coronary syndrome in the emergency department

Race and Sex Differences in Post–Myocardial Infarction Angina Frequency and Risk of 1-Year Unplanned Rehospitalization

Contact Info

Product

Resources

About